Organization
EWA ANTONCZYK MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATRINA M FERRALES (CREDENTIALING SPECIALIST)
(575) 647-8366
Entity
Organization
Contact information
Practice address
3850 FOOTHILLS RD, STE. 9, LAS CRUCES, NM 88011-4632
(575) 382-3700
(575) 382-3701
Mailing address
3850 FOOTHILLS RD, STE. 9, LAS CRUCES, NM 88011-4632
(575) 382-3700
(575) 382-3701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2005-0482
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64355381
—
NM
Enumeration date
05/22/2007
Last updated
05/06/2008
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